Gender Affirming Care and IBD

Gender Affirming Care is a spectrum and all depends on your journey as a transgender and/or gender non-binary individual - from surgical affirmation to hormonal therapy to social transition, don’t let IBD prevent you from becoming your best self.

Gender Affirming Hormone Therapy and IBD

Busting myths about HRT and IBD, what to expect when starting HRT with IBD, and navigating ‘Transgender Broken Arm Syndrome’

GAHRT (Gender Affirming Hormone Replacement Therapy) is used by  some transgender individuals who wish to transition medically. This includes, but is not limited to, Testosterone ( Testosterone Cypionate or Proprionate SubQ Injection, Intramuscular Injection, Nebido Pellet, Testogel, and Patches) Estrogen, Estradiol, Progesterone, GnRH antagonists/puberty blockers, spironolactone, and more.

Transgender Broken Arm Syndrome is the phenomenon of healthcare providers misattributing symptoms of disease to your HRT or gender identity - in this case, that may look like a flare being blamed/attributed to your HRT.

There is limited research on transgender IBD patient health, however, testosterone replacement therapy has been shown to decrease CRP and pro-inflammatory cytokines

In transgender men without IBD, gender-affirming hormone therapy led to a decrease in CRP and blood pressure

Recent research has shown there no overall risk for IBD flare in the year after gender-affirming hormone initiation.

Patients with active IBD and those who received testosterone were more likely to experience a flare.

A 2024 study at Johns Hopkins showed that GAHT was not associated with increased incidence of flares however

It is important to talk to your healthcare team about what matters most to you. Stress and anxiety associated with gender dysphoria can contribute to overall distress that compounds flares, so these are multifaceted decisions.

Talk to your GI doctor and endocrinologist (or prescribing provider of HRT) about your specific situation - not all IBD experiences are the same as not all TGNC experiences are the same.

DIY HRT and your liver function (LFTs)

With the rise in legislation restricting access to gender affirming care, many individuals have and may consider using ‘DIY’ HRT methods, including anabolic steroids, and/or supplementing with herbs and ‘feminizing’/’masculinizing’ supplements. PLEASE be careful doing this (I strongly do not suggest doing it), but if you are, you need to watch your liver function.
Many of these ‘supplements’ and OTC testosterone boosters are very hepatoxic (hurt your liver a lot) which is not good!
For example: ashwaganda, fenugreek, tribulus, maca, DHEA, tongkat ali, all of the Nugenix supplements, etc, can lead to your liver function tests (ALT/AST) becoming very out of whack.
If you do use these things, PLEASE make sure you are getting your LFTs and other bloodwork done regularly.

Gender Affirming Surgery and IBD

As always, this will be specific to your IBD  and transition journey and requires a conversation with your gastroenterologist, colorectal surgeon, and gender-affirming surgeon.

For individuals with fistulizing disease (Perianal, rectal, and preexisting pelvic floor disorders (eg, Crohn’s disease, prior radiation, prior trauma, and so forth) ,this may impact the tissue quality needed for reconstruction can affect your candidacy for all genital gender affirming surgery (phalloplasies, vulvoplasty, etc.

This is why it’s VERY important to let your doctor know if you notice any changes in your IBD or discomfort so you can have achieve your transition related goals!

Close communication between your  gastroenterologist, colorectal and gender-affirming surgeon, and radiologists is critical. Please do not ever feel hesitant to speak up if you feel something is not your 'normal'.

 This is not to be doom and gloom!! Many transgender people with IBD have had successful gender-affirming surgery - it is just VERY IMPORTANT that you keep all of your doctors and surgeons in the loop.

As with most LGBTQ+ health topics in IBD, there is very limited research and information regarding gender affirming surgery and IBD. It may be helpful to reach out to IBD doctors with training or speciality in LGBTQ+ health for help. Together we will figure it out!